A nurse receives a report on a client with a basilar skull fracture. What findings should the nurse expect with this client?

Choice A rationale
Maintaining the head of the bed between 30 and 45 degrees is a common intervention for a patient at risk of cerebral aneurysm rupture. This position can help reduce intracranial pressure and promote venous drainage from the brain.
Choice B rationale
Administering hypotonic intravenous solutions is not typically recommended for patients at risk of cerebral aneurysm rupture. Hypotonic solutions can lead to cerebral edema, which can increase intracranial pressure and potentially contribute to aneurysm rupture.
Choice C rationale
Keeping lights at a medium level in the evening is not a specific intervention for patients at risk of cerebral aneurysm rupture. While maintaining a comfortable and restful environment is important, there’s no evidence to suggest that the level of lighting has a direct impact on the risk of aneurysm rupture.
Choice D rationale
Repositioning the patient every shift is a standard nursing intervention to prevent pressure ulcers and promote comfort. However, it is not a specific intervention for patients at risk of cerebral aneurysm rupture.

Choice A rationale

Anhidrosis, or the inability to sweat normally, is a potential side effect of anticholinergic agents. These medications block the action of acetylcholine, a neurotransmitter that stimulates sweat glands among other functions. If a patient taking an anticholinergic agent for Parkinson’s disease experiences anhidrosis, they should report it to their healthcare provider as it can lead to overheating and heat stroke.
Choice B rationale
Tremors are a common symptom of Parkinson’s disease, and anticholinergic medications are often used to help control them. Therefore, while tremors should be monitored, they are not typically a side effect that needs to be reported unless they worsen or become unmanageable.
Choice C rationale
Drooling can be a symptom of Parkinson’s disease, but it is not typically a side effect of anticholinergic medications. In fact, these medications can sometimes cause dry mouth.
Choice D rationale
Rigidity, like tremors, is a common symptom of Parkinson’s disease. Anticholinergic medications can help manage rigidity, so it is not typically a side effect that needs to be reported unless it worsens.